find this slide presentation at feedback-in-meded feedback-in-meded professional development
TRANSCRIPT
Find this slide presentation at www.dfcmopen.com/item/effective-feedback-in-meded
PROFESSIONAL DEVELOPMENTBasics Program for New Faculty – Day 1: October 3, 2013
Presenters: Sarah Fleming MD CCFP, Gweneth Sampson MD CCFP FCFP MScCH Facilitators: Helen Batty, Allyson Merbaum, Sarah Reid, Michael Roberts, Gweneth Sampson, Monica Sethi,
Barbara Stubbs
Strategies for Effective Feedbackin Medical Education
Find this slide presentation at www.dfcmopen.com/item/effective-feedback-in-meded
This set of slides is adapted for DFCM Open. You can download these slides at www.dfcmopen.com/item/effective‐feedback-in-meded.
Find a handy one-page reference about giving feedback at www.dfcmopen.com/item/giving-feedback-basics.
Find this slide presentation at www.dfcmopen.com/item/effective-feedback-in-meded
The objectives of the “one-pager”, which includes a list of references, are as follows:
1. Describe the role, models and characteristics of constructive feedback in education.
2. Understand some of the common challenges and barriers to effective feedback, including the role of student self-assessment.
Learning Objectives
• Participants will be able to:– Describe the role, models, and
characteristics of constructive feedback in education
– Understand some of the common challenges and barriers to effective feedback, including the role of student self assessment
– Demonstrate feedback techniques
Overview of Workshop
• Background Information
• DVD: Resident scenario
• Feedback Role Play
• Feedback Checklist
• DVD: Small Group Exercise
• Summary
Key Messages
• Trainees state that feedback is the main item they don’t get enough of in teaching sessions (Hewson and Little,1998)
• The process of giving feedback is as important and structured as taking a good history
• Focusing on attaining a comprehensive student self-assessment and establishing a dialogue are keys to good feedback (Ende, 1983; Ramani & Krackov, 2012)
• We need to give better feedback - not necessarily more
Feedback: Definitions
• Feedback is the sharing of information on actual performance to help guide the student’s future performance toward a desired goal (Ramaprasad, 1983)
• It is essential to learning
• It requires a sample behaviour, a clear model of the desired behaviour, and a demonstration of the difference between the two
Types of Feedback
Formative• Aimed at
improvement• Gathered to
inform change
• Eg. Field Notes
Summative• After-the fact• Evaluation• Judgment
• Eg. End of Rotation Evaluations (ITERS)
Feedback is most useful when provided during a formative
evaluation
(Sadler,1989)
Why Give Feedback?
“Feedback can change physicians’ clinical performance when provided
systematically over time by an authoritative credible source”
(Velosky et al., 2006)
Feedback Models
• Sandwich Technique“positive/negative/positive”
• Pendleton Method (Cantillon and Sargeant, 2008)
• Relative Ranking System
• EFPO “6 Step” Model (Educating Future Physicians of Ontario)
EFPO Model of Feedback(Six Step)
1. Teacher observation of student behaviour or work
2. Ask the student for their self-assessment
3. Describe the desired behaviour
4. Ascertain that the student understands the difference between current behaviour and desired behaviour
5. Elaborate a plan to close the gap (an educational prescription)
6. Follow-up on improvement
Merrilee Brown, Brian Hodges, J.Wakefield, Effective Feedback, 1995
An Example - Parallel Parking
1. Observe student parallel parking (too far from the curb)
2. Ask for self assessment - “How do you think that went?” “What did you do well?”… “Is there anything that didn’t go as well as you had hoped?”
3. Describe desired behaviour - “You did a great job at checking the space around the car. Next time I would recommend parking closer to the curb… Indeed, this can be tricky sometimes”
4. Check if student understands the difference between current parking and desired parking – “What do you think about my suggestion of parking closer to the curb?” “How much closer would you like to be next time?”…“Yes, two feet closer sounds good”
An Example - Parallel Parking
5. Make a Plan to close the gap - “Is there anything that you can think of that may improve it for next time?” … “ I agree, and you could also try slowing down the car as you reverse. Why don’t you watch me park, then practice this again for 10 minutes every day”
6. Follow-up on improvement - “I will observe you park again in 3 days and we can touch base to see how things are going”
Characteristics of Effective Feedback
Characteristics of Effective Feedback: CORBS
Characteristics of Effective Feedback:
• Clear
• Observed (and Owned)
• Regular / Restricted
• Balanced
• Specific
Possible Barriers to the Provision of Effective Feedback
• Little or no instruction on how to give feedback
• Fear of damaging relationship with learners
• Hierarchy issues between teacher and learner
• Cultural context issues
• Students’ ability to self-assess
Self-Assessment of Competence: Why is it an important skill?
• Leads to increased motivation and improved knowledge, communication and performance (Evans, 2002)
• The ability to accurately assess one’s own strengths and weaknesses is the first step in self-directed learning (Boud, 1990)
• Physicians are responsible for their own continuing medical education
Self-Assessment of Competence:
Are we good at self-assessment?
Self-Assessment of Competence:
(Dunning and Kruger, 1999)
Risk group
Vicious cycle of
incompetence
average
Competence
Self assessment
high
Risk group
highlow
Burnout
potential
Self-Assessment of Competence:
Can we improve our self-assessment skills?
Self-Assessment of Competence:
(Dunning and Kruger, 1999)
Risk group
average
Competence
Self assessment
high
Improved competence creates improved self assessment skills
Risk group
highlow
- insight- ability to use feedback
Burnout potential
Self-Assessment of Competence:
average
low
Self assessment
high Improvement in self assessment after viewing “benchmark” videos
(Martin et al., 2004)
high
Competence
(Dunning and Kruger, 1999)
Feedback and Reflection
• Feedback self-assessment reflection
• Although self-assessment is often inaccurate, self assessment skills can be learned
• Reflection and self-assessment are critical for lifelong learning
• Reflection accelerates learning and improves the depth of understanding (Westberg & Jason, 2001)
• Reflective practioners are likely to provide better patient care
Useful Rules for Role-Play and Debriefing• Preferable to recruit volunteers, not assign roles
• Refusal always allowed
• Time out whenever needed “T”
• Role players debrief first
– most anxiety provoking roles first (no interrupting)
– may be given a reasonable time limit in advance
• Role players discuss first
– with each other
– ask observers questions for specific feedback and advise them of areas “off limits” for comment
• Observers provide specific careful feedback following guidelines
– use data from field notes “quotations” etc.
– respect requests and limitations set by role players
• Time keeper keeps track of start and stop timesBatty’s Rule: 1 minute of role playing 2 to 10 minutes of debriefing
Large Group Debrief
• What strategies worked?
• What was a challenge?
• What will you try in future?
Wrap-Up - Review of our learning objectives
• Participants will be able to:
– Describe the role, models, and characteristics of constructive feedback
– Understand some of the common challenges
– Demonstrate feedback techniques
Practical Tips
• Label this as “Feedback”
• Think about Timing and Privacy
• Link to Learner’s Objectives
• Provide Opportunity for Change
• Get Feedback on your Feedback
• Follow-Up
Key Messages
• Feedback is crucial to the improvement of performance, self assessment skills and reflective practice
• Process = 6 step EFPO model: observe, student self-assessment, describe behaviour, describe the gap, make an educational plan and follow up
• CORBS: Clear, Observed, Regular, Balanced, Specific
• Just do it (and label it!)
References
• Branch W and Paranjape A (2002). Feedback and Reflection: Teaching Methods for Clinical Settings. Academic Medicine 77 (12): 1185-1188
• Cantillon P and Sargeant J (2008). Giving feedback in clinical settings. BMJ 337:a1961.
• Davis D, Mazmanian P, Fordis M, Van Harrison R, Thorpe K, Perrier L (2006). Accuracy of Physician self-assessment compared with observed measure. JAMA 296(9):1094-110
• Dunning D, Kruger, J (1999). Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments. Journal of Personality and Social Psychology 77 (6): 1121-34.
• Eva K and Regehr G (2013). Effective feedback for maintenance of competence: from data delivery to trusting dialogues. CMAJ April 2; 185:463-464
• Evans A, McKenna C, Oliver M. (2002). Self-assessment in medical practice. J R Soc Med 95:511-513.
• Hewson MG, Little ML. (1998). Giving feedback in medical education: Verification of recommended techniques. J Gen Intern Med 113:111–118.
References
•Mann K, Gordon J, Macleod A. (2007) Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Edic Theory Pract 2007;14:595-621.•Martin D, Regehr G, Hodges B, McNaughton N. (1998) Using videotaped benchmarks to improve the self-assessment ability of family practice residents. Acad Med. Nov 73(11): 1201-6.•Ramani S, Krackov S. (2012). Twelve tips for giving feedback effectively in the clinical environment. Medical Teacher 34:787-791.•Ramaprasad A (1983) On the definition of feedback. Behav Sci 28:4-13.•Sadler, DR (1989) Formative assessment and the design of instructional systems. Instructional Science 18:119-144.•Sandars J. (2009). The use of reflection in medical education: AMEE guide 44. Med Teach 31:685-95.•Veloski J, Boex JR, Grasberger MJ, Evans A, Wolfson DB. (2006). Systematic review of the literature on assessment, feedback and physicians' clinical performance: BEME Guide No. 7. Med Teach. Mar;28(2):117-28.•Westberg, Jane & Jason, Hilliard. (2001) Fostering Reflection and Providing Feedback, New York: Springer Publishing Co.
Find this slide presentation at www.dfcmopen.com/item/effective-feedback-in-meded
Thank You!Thank You!